Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Friday, November 9, 2012

Cool Technology of the Week

While I was at AMIA this week, Will Ross of Redwood MedNet, introduced me to a low cost interoperability solution for small practices in rural locations. It's similar in concept to the interoperability appliances that Massachusetts has used in its HIE. Will calls his appliance the
"HIE Plug".

The HIE Plug is a secure health data endpoint built on a generic small form factor hardware device. The all open source software stack runs on a Marvel Kirkwood ARM CPU @ 1.2Ghz with 512M RAM. The hardware draws under 5 watts of power.

The HIE Plug open source software stack installed on the device includes:

1. Debian Wheezy with the Linux 3.* kernel.

2. EncFS provides an encrypted filesystem in user-space running without any special permissions and with the FUSE library and Linux kernel module to provide the filesystem interface.

3. Mirth Connect - health data integration engine, a robust Enterprise Service Bus tool fluent in all common health data formats and communication services. Mirth Connect includes a robust dashboard to manage many individual integration engine channels, which can be taught variously to listen for data, push data, pull data, transform data, etc. Mirth Connect channels are written in Javascript.

4. Apache Derby database stores the health data messages prior to forwarding to the HIE. The database runs in the encrypted filesystem. If power to the device is lost the part of the filesystem where the database resides cannot be re-mounted and unencrypted without the proper credentials. Local storage can be configured to trim/remove its local store of messages at a pre-defined time.

6. Samba (file server) and CUPS (print server) installed. Either one or both can be configured and deployed as needed - - no services are enabled by default. This allows delivery or consumption of a file through a shared folder on the HIE Plug, or delivery of a print job to an internal network printer or a remote network printer.

7. lighttpd webserver - to provide web based applications or information to clients.

The HIE Plug was tested in a pilot deployment at three sites in early 2012, and is now rolling out to general production across dozens of health care facilities participating in Redwood MedNet. Up front deployment cost is $300 per practice. Technical support by Redwood MedNet is included under the standard HIE bidirectional data service subscription fee, which is $200/provider/year for outpatient practices.

Mirth has been used for Direct demonstrations, so it is a very reasonable choice as an integration engine supporting Meaningful Use Stage 2 exchanges.